骨科手术后监测血清C-反应蛋白的临床价值

作者对51例骨科手术患者进行连续性血清C—反应蛋白(CRP)和体温监测。发现手术创伤和感染都可使患者CRP和体温升高。术后当感染控制良好时,CRP迅速下降至10mg/l以下,当组织完全愈合时CRP均值为7.6mg/l。如感染持续存在,CRP则下降迟缓,维持在较高水平并出现波动。表明CRP能比体温更灵敏,更准确地预示感染和反映抗感染治疗的效果。     

血清白介素-6、白介素-10、C-反应蛋白对全关节置换术后早期感染的诊断价值

目的探讨血清白介素(IL)-6、IL-10、C-反应蛋白(CRP)对全关节置换术后早期感染的诊断价值。方法选择人工髋、膝关节置换术(观察组)患者38例,同时设立健康人员对照(对照组)34例,以化学发光免疫法测定IL-6、IL-10水平,采用免疫比浊法测定CRP水平,观察患者关节置换术前1 d及术后1、3、5、7d血清IL-6、IL-10、CRP水平的变化。结果对照组血清IL-6、IL-10、CRP水平分别为(3.24±0.56)ng/L、(8.15±2.28)ng/L、(1.68±0.31)mg/L。术前1 d观察组与对照组比较,IL-6、IL-10、CRP水平差异无统计学意义(P0.05)。术后1、3、5 d观察组IL-6、IL-10、CRP水平均明显高于对照组,差异有统计学意义(P0.05)。术后7 d观察组IL-6、IL-10水平与对照组比较无明显差异(P0.05),CRP水平明显高于对照组(P0.05)。观察组患者术后1 d血清IL-6、IL-10水平明显升高,术后3、5、7 d逐渐下降(P0.05),术后1、3 d血清CRP水平逐渐增加,术后5、7 d逐渐下降(P0.05),术后7d患者血清IL-6、IL-10水平与术前1 d比较差异无统计学意义(P0.05),术后7 d血清CRP水平高于术前1 d(P0.05)。结论血清IL-6、IL-10及CRP均能于早期反映全关节置换术后炎症状态,但IL-6、IL-10更敏感、准确率更高,对早期诊断全关节置换术后感染更有价值。     

C-反应蛋白在骨折内固定术后迟发性感染的临床应用

目的探讨C-反应蛋白（CRP）在骨折内固定术后迟发性感染患者的临床应用及意义。方法 62例患者就诊时和抗生素治疗1周、2周、4周等后分别静脉采血,检测血清CRP、血沉（ESR）及白细胞计数（WBC）。结果设CRP〉8.0mg/L为阳性、WBC〉10.0×109/L为阳性,ESR〉20mg/h为阳性;其中就诊时CRP阳性率98.38%,WBC阳性率30.65%,ESR阳性率41.94%,χ2检验有显著差异（P〈0.01）。62例CRP〉8.0mg/L患者抗生素治疗或内固定物拆除术后CRP下降明显,治疗前后CRP、WBC、ESR水平t检验,CRP、ESR有显著差异（P〈0.01）;WBC无显著差异（P〉0.05）。结论 CRP是骨折术后迟发性感染诊断的敏感指标,并指导合理使用抗生素并判断疗效。     

联合检测降钙素原、血沉、C-反应蛋白在膝关节置换术后感染的临床意义

目的：探讨血清降钙素原（ PCT）、血沉（ ESR）、C-反应蛋白（ CRP）联合定量检测在诊断膝关节置换术后感染的指导意义。方法选取2007年1月至2013年7月,新疆维吾尔族自治区人民医院骨科中心收治的21例膝关节置换术后感染的患者,同期膝关节置换术后非感染患者42例作为对照组。采用双抗体夹心免疫化学发光法（ ILMA）测定PCT水平,采用采用魏氏（ Westergren）法测定ESR水平,采用全自动免疫透视比浊法测定CRP水平。结果与膝关节置换术后非感染患者比较,膝关节置换术后感染患者的PCT、CRP、ESR显著高于非感染组,有统计学差异（χ2值分别为46.53、24.04、42.51,P均小于0.05）。结论 PCT、ESR及CRP的联合检测有助于膝关节置换术后感染的诊断,对及时合理应用抗菌药物及二次手术干预有重要的指导意义。     

血清C-反应蛋白鉴别系统性红斑狼疮活动与感染的意义

目的:探讨血清C-反应蛋白(CRP)鉴别系统性红斑狼疮(SLE)活动和感染的临床意义.方法:收集1998年6月～2003年6月在我科住院治疗并行过血清CRP检测的共77例SLE患者,分为感染组与非感染组,并比较了他们的CRP浓度.结果:SLE患者感染组CRP浓度(65.24±36.08)mg/L明显高于非感染组(9.05±11.61)mg/L,两者有统计学差异(P＜0.01);而非感染组中狼疮活动与非活动组CRP浓度无统计学差异(P＞0.05).CRP＞30 mg/L诊断SLE合并细菌感染的敏感性为89.3%,特异性达92.6%.结论:CRP可以作为一个鉴别SLE患者活动与感染的敏感实用的指标,若＞30 mg/L应首先考虑合并感染.     

C-反应蛋白测定与B超检查对术后腹腔感染诊断的价值

本文对240例腹部手术患者进行了连续的血清C一反应蛋白及B超检查,其中18例术后腹腔感染及时诊断。本组40例C—反应蛋白持续升高,但是,B超检查阴性,最后只有2例诊断腹腔感染。另有9例B超发现腹腔局限积液或脓肿,但是,C—反应蛋白不升高,最后仅2例证实有腹腔感染。本组有14例C—反应蛋白升高,同时B超发现有腹腔局限性积液或脓肿,最后均证实有术后腹腔感染。     

翻修术前C-反应蛋白对人工髋关节感染的诊断价值

目的评价翻修术前C-反应蛋白(CRP)对人工髋关节感染的诊断价值。方法对145例人工髋关节翻修患者进行回顾性分析,以CRP作为诊断标准对人工髋关节感染进行诊断,并与“金标准”的诊断结果进行比较分析。结果以CRP作为人工髋关节感染的诊断标准,其诊断的灵敏度为68.42%,特异度为88.89%,阳性预测值为48.15%,阴性预测值为94.92%,准确度为18.62,Youden指数为0.57。结论CRP作为人工髋关节翻修术前的常规检查,对人工髋关节感染的诊断具有筛选价值。     

全膝关节置换术后CRP和ESR变化的临床研究

目的测定TKA术前术后C-反应蛋白（CRP）和红细胞沉降率（ESR）的水平并寻找其随时间变化的规律。方法对进行单或双侧初次全膝关节置换术的65例患者进行前瞻性研究,对所选病例术前及术后1、2、5、7、14、42、90d的CRP和ESR进行测定．并进行统计学分析。结果单侧TKA组和双侧TKA组的术前术后CRP和ESR变化模式相似,CRP第2天达到高峰（P〈0．05）,术后在42d后恢复到正常范围内,术后90d后大致恢复到术前水平（P〉0．05）;ESR术后第2天升高后,术后第5天到达高峰（P〈O．05）,而后逐渐下降,术后90dESR下降到正常范围并接近术前水平,差异无统计学意义（P〉O．05）。结论熟练掌握TKA术后CRP和ESR的变化规律,结合术后时间轴,有助于TKA术后感染的早期诊断．CRP较ESR更加具有临床意义。     

腰椎手术后血清C-反应蛋白与血沉定量分析及临床意义

目的：为４种腰椎术式术后血清Ｃ－反应蛋白（ＣＲＰ）提供临床反应参数，并与红细胞沉降率（ＥＳＲ）做对比，探讨二者在腰椎术后体现的临床意义。方法：对开窗髓核摘除组（４３例）、侧椎管减压组（２８例）、全椎板切除组（１３例）和后路减压植骨组（９例）四种常用腰椎术式病人术后血清ＣＲＰ进行１～３５ｄ动态监测，并与血沉做对照分析。结果：所有病人术后ＣＲＰ值均升高，２～３ｄ达到峰值，１０ｄ后回落至正常水平。各组术式ＣＲＰ值存在差异（Ｐ＜０．０１）。与ＥＳＲ相比，ＣＲＰ高峰出现早，回落周期短，稳定性好。结论：腰椎术后ＣＲＰ持续性或二次升高者要考虑感染存在。与ＥＳＲ相比较，ＣＲＰ具有灵敏性高，准确性强之优点，可望作为早期判断腰椎术后感染的重要指标。     

C-反应蛋白和血清降钙素原对危重患者感染的监测价值研究

目的探讨C-反应蛋白（CRP）和血清降钙素原（PCT）对危重患者感染的监测价值。方法收集2012年10月至2013年10月本院ICU病房收治的98例危重患者,根据辅助检查结果将其分为细菌感染组（68例）和病毒感染组（30例）两组,对其PCT和CRP含量进行测定。并将细菌感染组患者随机分为观察组和对照组,每组各34例;动态监测其治疗前后PCT和CRP含量的变化情况。结果细菌感染组和病毒感染组患者的PCT平均含量分别为（3.64±0.58）μg/L和（0.37±0.35）μg/L,差异具有统计学意义（t=2.437,P〈0.05）。细菌感染组和病毒感染组患者的CRP平均含量分别为（38.27±20.55）mg/L和（37.91±20.63 mg/L）相比,差异无统计学意义（t=0.694,P〉0.05）。观察组治疗后PCT的平均含量由治疗前的（3.68±0.62）μg/L下降为（0.53±0.21）μg/L,相比于对照组由治疗前的（3.59±0.51）μg/L下降为（2.67±0.43）μg/L,下降幅度更大;观察组治疗后CRP的平均含量为（13.81±5.64）mg/L,显著低于对照组的（21.53±5.38）mg/L,差异具有统计学意义（t=5.724,P〈0.05）。结论 PCT和CRP含量的动态监测在临床应用时各有优势,二者联合应用,在对危重患者感染的诊断和治疗中具有极高的临床价值。     

人工关节置换术后早期感染的治疗措施

目的探讨人工关节置换术后早期感染治疗的措施及临床疗效。方法对13例(髋关节9例、膝关节4例)人工关节置换术后感染的患者采用"抗生素全身治疗、局部彻底清创、持续灌洗引流和碘伏间歇保留灌洗"多重措施治疗。结果患者感染早期均得到了控制。随访1~10年,未见感染复发,关节功能良好。结论早期强有力和足疗程的抗感染治疗、早期彻底的清创加持续灌洗引流、碘伏间歇保留灌洗配合抗生素治疗是成功治疗人工关节置换术后早期感染的3个关键措施。     

C-reactive protein in the monitoring of acute rejection after heart transplantation

Histological examination of endomyocardial biopsy (EMB) is the main technique for rejection surveillance after heart transplantation. This technique is elaborate, inconvenient for the patient, and not without complications. We prospectively analyzed whether the measurement of C-reactive protein (CRP), an acute phase protein that quickly rises when there is inflammation, can serve as a marker for immunological quiescence and as an indicator for withholding EMB. During a 6-month period, CRP was measured in all patients referred for EMB as part of the routine follow-up after heart transplantation. Acute rejection in patients with a follow-up of more than 1 year was rare (1/76). In the majority of cases, EMB was taken within the 1-year post-transplantation (170/246 = 69 %). In 71/170 biopsies (42 %), CRP was ≤ 1; in the other 99/170 (58 %), CRP was ≥ 2. When CRP was ≤ 1, acute rejection was diagnosed in 12/70 cases (17 %). In contrast, acute rejection was found in 28/99 cases (28 %) with CRP ≥ 2 (P = 0.1). Although CRP is elevated more often in the presence of acute rejection, its sensitivity does not allow CRP to replace the routine performance of EMB for monitoring rejection after heart transplantation. We did, however, find a prognostic significance with regard to the effect of rejection treatment: in all acute rejections with a CRP ≤ 3 (n = 11), steroids were effective. Received: 6 January 1998 Received after revision: 7 April 1998 Accepted: 20 April 1998     

The C-reactive protein for detection of early infections after lumbar microdiscectomy

Summary The tendency for short hospitalization after lumbar microdiscectomy implies the need for early confirmation or disproval of serious postoperative infections such as spondylodiscitis or deep wound infections. The C-reactive protein (CRP) is a well-known screening parameter for monitoring postoperative infectious complications in other fields. Our objective was to establish the diagnostic significance of CRP-in comparison with ESR and WBC-for monitoring infectious complications after lumbar microdiscectomy. Over a 15 months period we studied prospectively a homogeneous group of N = 400 patients with lumbar disc herniations who were operated on a single level for the first time. CRP, ESR and WBC values were determined in all patients pre-operatively, and on postoperative days 1 and 5. Clinical and laboratory findings were correlated and the diagnostic significance of CRP, ESR and WBC calcualted. N = 385 (96%) patients had an uneventful postoperative course. N = 15 (4%) patients developed infectious complications, of which N = 6 (1.5%) were unrelated and N = 9 (2.5%) related to surgery. Evaluation of the laboratory values showed: The CRP baseline is a very individual value of no prognostic relevance. A high postaggression peak is typical and essential as a reference value for only the future time course will disclose any infection. We found 0% false negative and 4% false positive results on day 5. The sensitivity for serial CRP testing was calculated as 100% and specificity as 95.8%. ESR (sensitivity: 78.1%/specificity: 38.1%) and WBC (sensitivity: 21.4%/specificity: 76.8%) both failed to reach such distinct diagnostic significance on day 5. The C-reactive protein has thus proved to be a reliable, simple and economical screening test for infectious complications after lumbar microdiscectomy, superior to classical laboratory parameters.     

四肢骨折手术前后C反应蛋白的变化及其临床意义

目的探讨四肢骨折手术前后C反应蛋白（CRP）的变化及其临床意义。方法抽取骨折手术患者入院时、术前1 d、术后1-6 d及12 d的血标本,用散射比浊法测量CRP。结果术后无并发症的患者CRP变化相似：术后2 d出现的峰值水平与骨折部位有关,并反映手术创伤程度。深部切口感染术后4 d CRP临界值为96 mg/L。结论根据CRP反应动力学确定骨折术后时间相关的CRP参考值。CRP偏离参考值特别术后4 d〉96 mg/L,有助于早期发现术后感染并发症。     

骨折患者内置入手术治疗前后血清C-反应蛋白变化的意义

目的探讨骨折患者内置入手术治疗前后血清C-反应蛋白(CRP)变化的意义。方法 200例行内置入手术治疗的骨折患者中,采用微创手术治疗109例(微创组),采用传统开放手术治疗91例(传统组)。比较两组患者术前及术后1、3、7 d血清CRP水平变化。然后依据术后是否发生感染,分为感染组(2例)和未感染组(198例),比较两组各时段血清CRP水平变化。结果术前血清CRP水平微创组和传统组比较差异无统计学意义(P0.05),术后各时段微创组均较传统组显著降低(P0.05)。与术前比较,微创组术后1、3 d和传统组术后各时段均显著升高(P0.05);与术后1 d比较,两组术后3、7 d均明显降低(P0.05)。术后2例患者发生感染,感染率为1%。感染组与未感染组比较,术前血清CRP水平差异无统计学意义(P0.05);与术前比较,感染组术后各时段、未感染组术后1、3 d血清CRP水平均明显升高(P0.05);与术后1 d比较,感染组术后3 d明显升高(P0.05),未感染组术后3、7 d均明显降低(P0.05)。结论采用微创内置入手术治疗骨折患者血清CRP变化幅度明显低于传统手术。血清CRP水平在术后感染患者中显著升高,可作为感染诊断的重要辅助指标。     

Mildly decreased preoperative bilirubin levels are associated with infections after shoulder and knee arthroplasty

Increasing numbers of arthroplasties are also accompanied by postoperative infections. The main purpose was to evaluate preoperative serum bilirubin levels between patients with and without infections after shoulder and knee arthroplasties. For this retrospective case-control single-center study, a total of 108 patients were extracted from a prospectively collected database. Eighteen patients with infections after shoulder (n = 8) and knee (n = 10) arthroplasty were matched by age, gender, and implant type in a 1:5-scenario to 90 patients (40 shoulders and 50 knees) without postoperative infection. Demographic data, preoperative blood parameters, and postoperative infection-related outcomes were evaluated. Total bilirubin was the only preoperative parameter significantly different between the infection (8.21 ± 3.25 μmol/L or 0.48 ± 0.19 mg/dL) and noninfection (10.78 ± 4.62 μmol/L or 0.63 ± 0.27 mg/dL; P = .014) group, while C-reactive protein and other liver parameters were similar between the groups. Significantly more controls (92.1%) had preoperative bilirubin levels above 8.72 μmol/L or 0.51 mg/dL than cases (7.9%; P = .007). The 5-year infection survival-rate was 65.6% for patients with preoperative bilirubin levels < 8.72 μmol/L or < 0.51 mg/dL and 91.2% with ≥ 8.72 μmol/L or ≥ 0.51 mg/dL. Mildly decreased preoperative bilirubin levels with a cutoff at 8.72 μmol/L or 0.51 mg/dL were significantly associated to patients with infections after shoulder and knee arthroplasty. There were no differences in other blood parameters or comorbidities between patients with infections and their matched-controls.     

Post-transplant C-reactive protein monitoring can predict chronic allograft nephropathy

Chronic allograft nephropathy (CAN) is a major problem after renal transplantation and chronic inflammation can be one of its promoters. C-reactive protein (CRP) is an important marker of inflammation and atherosclerosis. We retrospectively analyzed the predictive role of serum CRP levels on the development of CAN and graft failure. One hundred and twenty-five renal transplant patients were randomly included into the study. Serum CRP levels were measured at pre-transplant period, first month after transplantation and at yearly intervals throughout follow-up. CAN was diagnosed in 40.8% of patients and 82.4% of them had graft failure in 60.9 +/- 36.7 months. There was no difference at pre-transplant CRP levels of patients with and without CAN, but the first month CRP levels were higher in those who experienced CAN. The initial 3-yr mean CRP levels were higher, but not statistically different between the patients with and without CAN. The simultaneously detected CRP levels when CAN were diagnosed was significantly higher in those with CAN. High post-transplant CRP levels at the first month and at the diagnosis of CAN significantly influenced the allograft failure according to the regression analysis. CRP monitoring gives important information about the risk for CAN and graft failure. Therefore, CRP levels should be included in the follow-up data after renal transplantation.     

急性出血性脑卒中患者术后血清白细胞介素6与C-反应蛋白动态检测及其临床意义

目的:探讨在急性出血性脑卒中患者术后白细胞介素6和C-反应蛋白的变化规律和作用以及与病情转归的关系。方法:检测45例患者术后1天、3天、5天、7天、10天的白细胞介素6和C-反应蛋白的血清浓度,和对照组进行对比,同时记录发病时病情评分。结果:术后第一天血清白细胞介素6水平即达峰值,第三天呈下降趋势,第十天已基本恢复正常,血清C-反应蛋白延迟于白细胞介素6出现,第一天即升高,到第三天达峰值,以后逐步下降,与对照组比较,有显著性差异(P<0.01),二者增高程度都与病情密切相关(P<0.01)。结论:急性出血性脑卒中的患者术后血清白细胞介素6和C-反应蛋白的测定对判定脑组织损害轻重,机体免疫状态和临床上判定疗效和预后具有很重要的意义。